The view from the frontline of the Darzi report & Labour's response.
As the 'secret consultant' points out:
'We cannot expect the NHS to improve population health on its own.... the reduction in productivity is not due to staff working less hard, rather our time is increasingly spent trying to mitigate failings elsewhere'!
Its pretty clear that prevention & resolving social shortcomings around nutrition and lifestyle 'choices' are the key to helping the NHS.
I made a slightly different point in another conversation yesterday. If you look at international comparisons - some in graphical form here: https://www.kingsfund.org.uk/insight-and-analysis/blogs/comparing-nhs-to-health-care-systems-other-countries - what you find is that the NHS is still comparatively efficient in cost-benefit terms, but very obviously lacks investment in equipment and staff.
The government's emphasis on efficiency, on reform before investment, and especially on using private healthcare providers (which work by attracting away NHS staff) therefore seem to me precisely the wrong prioritisation - indeed the opposite of what is really needed, which is more staff and equipment for the NHS.
Moreover, I suspect the same is true on the prevention side too. Health problems arising from poor housing, diet, stretched social services, etc, all need investment - which in many cases would pay for itself - recent research into, for example, universal free school meals, showed how - https://urbanhealth.org.uk/insights/reports/expanding-free-school-meals-a-cost-benefit-analysis
The #nhs has been shown to be cost effective repeatedly - which was why it served as a model for #taly and #spain the later 1970s and why #margaretthatcher rejected the idea of replacing it with a form of #socialinsurance a few years later. Even if more use of the private sector added to capacity it would do so at exorbitant cost - as of twenty years ago it was as much as 60% to 70% higher than #nhs provision on a like for like basis - although the premium fell later .
Buying in capacity from the private sector will drain the #nhs of resources even further - unless perversely it is treated as a 'reform' for which extra funding in made available ! Improving the #nhsestate by tackling the maintenance backlog first and also buying more kit such as scanners and other diagnostic tools could pay off quite quickly. The #foundationtrust I was a #governor
of sorted out its backlog in about a year by identifying the problems and spending money!
Yes, it requires a shift from crisis management to strategic planning, which is always difficult when budgets have been held so tight - if they continue to be he'd tight (without 'reform') then I think we'll agains see a lot of money wasted on the mechanism of reform rather than the (real) mechanics of health care.... (well that's how it seems from outside the system)
A very fair point . The incentives in the 2010s were for #nhstrusts to effectively 'cook the books' by raiding maintenance budgets in order to qualify for #foundationtrust status!
Emeritus Prof Christopher May
GeofCox
Donald Roy